About your PICC line and how to look after it. Information for patients Infectious Diseases & Tropical Medicine

Transcription

1 About your PICC line and how to look after it Information for patients Infectious Diseases & Tropical Medicine

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3 About your PICC line This booklet explains what a PICC line is, how it is put in and some general information on what it is used for and how to look after it. What is a PICC line? PICC is short for Peripherally Inserted Central Catheter. It is a soft, flexible tube which is put into a vein in your arm. This is what it looks like What is it used for? We will be able to give you fluids, medication and also nutrition through the PICC line. It is also possible to take blood samples through the PICC line in some cases. How is a PICC line put in? The person who puts your line in will explain the procedure to you. She/he will then ask you to sign a consent form to say that you have understood this information and the potential risks and complications related to this. page 3 of 16

4 We will put some local anaesthetic cream on your arm to numb the skin. This will take about one hour to work. Once the anaesthetic cream has worked, we will insert the line into one of the veins in your arm. In some cases we may also give you an injection of local anaesthetic. The line is then moved along the vein until the tip reaches a large vein in your chest. You should not feel the line moving along the vein. Once the line is in, we will tape it in place and cover it with a clear dressing to keep it clean. We will then take an X-ray to make sure the line is in the correct position. Once the X-ray has been checked to confirm that the line is in the right place, we can start using your line. page 4 of 16

5 Does it hurt? Having a PICC line put in is not an uncomfortable procedure. The local anaesthetic cream numbs your skin so having a PICC line inserted should feel similar to having a blood sample taken. How long does it take to put a PICC line in? Inserting a PICC line usually takes about 30 minutes, but in some cases it may take longer. Will I be able to feel the line once it is in place? You may feel some tenderness in your arm for the first hours after the line has been put in. However, after that, you will become less aware of the line being there and you should find that you are able to continue with your normal activities. It is important that you avoid heavy physical activity as this may cause inflammation of the vein or dislodge the line. How soon after the line has been inserted can I go home? You can go home once the X-ray has been checked to confirm that your line is in the correct position. You do not need to stay in hospital. Before you go home you will have been given an appointment to return back to OPAT the following day to check that both you and your line are ok. How long will I need the PICC line? How long the line stays in will depend on the treatment that you are having. However, PICC lines can be safely left in place for several months if necessary. page 5 of 16

6 Are there any risks? Yes, whilst having a PICC is a safe procedure, it is important that you are aware of the risks and complications that can occur. People can have problems both during and after the line has been put in. However, complications are rare and are usually easily dealt with. The risks will be discussed with you in more detail by the person inserting the line. The risks during insertion are: Difficulty finding a vein when putting the line in If we do have any difficulty in finding a vein for the line or trouble putting it in place, then we will stop the procedure and talk about other options with you. The tip of the line does not reach its planned position The X-ray to check the position of the line will tell us if your line is too long or is not in the correct position. We can sometimes shorten the line or move it to a better position. This is a very minor procedure and will be done the same day. Bleeding and bruising from around the insertion site It is normal in the first 24 hours after a line is fitted for you to experience a small amount of bleeding from where the line goes in. You may also have some bruising but this will clear up within a few days. There are some possible problems that can happen after a PICC line has been put in and these are: Inflammation of the vein caused by the line (mechanical phlebitis) - your arm may feel warm, sore or swollen. Inform the nursing staff as this can be treated by applying a heat pack to the affected area page 6 of 16

7 The line becoming dislodged, or falling out - if you think the line looks longer, inform the nursing staff Infection in or around the line - if the entry site looks red or there is a discharge, inform the nursing staff The line becoming blocked The formation of a blood clot around the line Most people do not have any serious problems with their PICC line. Who will look after my line? Whilst you are in hospital, the nurses on the ward will look after your line. If you are going to be discharged home with the line in place, you can be trained to look after your own line, or some patients prefer to have a relative or friend to do this for them. There are benefits of doing this as it can reduce the risk of infection in the line. If you want a relative or friend to look after your PICC, the nurse specialist at the hospital can teach them. Further information will be given to you and your relatives before you are discharged home. page 7 of 16

8 What if I choose not to have a PICC? If you decide that you do not want to have a PICC line put in it may be possible to have an alternative line such as a Skin Tunnelled Cuffed Central Catheter (Hickman line). Ask the nurse or doctor looking after you for more information on this type of line. If you do choose not to have a PICC put in there may be a delay in you receiving your treatment. Sometimes it may mean that you are not able to receive some types of treatment as they cannot be given in any other way. Your OPAT nurse will discuss these with you. page 8 of 16

9 Looking after your PICC line What care does my line need? To reduce the risk of infection or line blockage, it is important that your line is cared for correctly. Please make sure that: The dressing covering your line is changed on the day after it has been inserted The dressing is changed at least once a week If not in use, the line is flushed once a week to make sure it is still working Who will look after my line? The OPAT team will ensure that your line is cared for and will change your dressing weekly, and check that the line is working well. Can I continue with my everyday activities with a PICC line? There is no reason why you should not continue with your normal activities such as work, exercise and sex. However, because of the risks of infection, inflammation or of dislodging your line do not: go swimming play sports like golf or tennis where you use your arm repetitively lift weights do heavy manual work page 9 of 16

10 What problems might I have with my line? Whilst most people rarely have problems with their line, you should be aware that you could experience any of the following: the line moving, becoming dislodged or falling out the formation of a blood clot around the line infection in or around the line inflammation of the vein caused by the line (mechanical phlebitis) the line becoming blocked the line splitting bleeding around the insertion site Below we explain how to recognise these problems and what to do if they should happen. The line moving, becoming dislodged or falling out How will I know if my line has become dislodged? Although the dressing holds the PICC line in it is still possible for it to move. It is helpful if you can remember how long the line is when it is inserted. If the line appears to be longer than usual then it may have become dislodged. You can guard against this happening by taking care not to catch or pull the line, this is especially important if you are attached to a drip. PICC lines can also become dislodged when the dressing is being changed. You can help to prevent this by placing a thumb or finger over the dressing at the point where the line enters your arm when the dressing is being removed. If you think that your line has slipped then please contact OPAT Specialist Nurses for advice. page 10 of 16

11 Formation of a blood clot How will I know if there is a blood clot in or around my line? This is a rare problem but one which can become serious if you do not seek advice. If your arm, fingers or neck appear swollen, discoloured or are painful contact the OPAT Specialist Nurses immediately for advice. (Further contact numbers are at the end of this booklet) Infection in or around the line How will I know if I have an infection in my line? Infection can develop into a serious problem. This means that it is important that you know how to recognise the signs of infection. These are: pain, redness or swelling around the line feeling hot and shivery, or cold and shivery or feeling generally unwell a temperature above 37.5 C What should I do if I think I have an infection in my line? If you have any of these signs you must contact OPAT Nurse Specialists straight away for advice (contact numbers are at the end of this booklet). How can I reduce the chances of my getting an infection in my line? You can reduce the chances of getting an infection by keeping the line clean and dry. The following will help you to do this: do not touch the line except when cleaning or dressing it do not let the area around your line get wet always ensure that your line is covered with cling film when bathing or showering. Alternatively the OPAT nurses can advise you on how to obtain a PICC shower sleeve. page 11 of 16

12 Inflammation It is not unusual for your PICC line to irritate the lining of the vein and cause inflammation. This is called mechanical phlebitis. How will I know if I have mechanical phlebitis? Mechanical phlebitis is most likely to happen in the first week after your line has been inserted although it can occur at any time. The signs of mechanical phlebitis are similar to those of infection, for example; you may notice redness or swelling of your arm above the area where the line goes in. However, the difference between this and infection is that you should not have a high temperature, feel unwell or have a discharge from around your line. If you are not sure whether you have an infection or mechanical phlebitis then please contact your OPAT Nurses for advice. (Contact details given at the end of this booklet) How can I treat mechanical phlebitis? You can reduce the chances of getting mechanical phlebitis by applying a heat pack to your arm for the first 3 days after your line has been inserted. We advise that you do this for 10 minutes, four times a day. To make a heat pack, you can use a hot water bottle filled with warm tap water, wheat pack warmed in the microwave or a flannel that has been run under a hot water tap and wrung out. Please make sure that the heat pack is not too hot because it may burn your skin. If the redness of swelling does not get better after 24 hours or if you become unwell, you must contact your OPAT Nurses for advice. (Contact details given at the end of this booklet). page 12 of 16

13 Line blockage How will I know if my line is blocked? Your PICC line will be flushed weekly to keep it working properly. If you find that you are experiencing difficulties with flushing your PICC line, or you are unable to do so easily, it may mean that your line is blocked. Do not try to force fluid through the line if it is blocked If you think your line may be blocked, contact your OPAT nurses for advice. (Contact details given at the end of this booklet) Splitting of the line How will I know if my line is split? It is rare for your PICC line to split or break. However, if the line does split or break, this is most likely to happen at the end near to the cap. This is usually caused by the line being allowed to twist too much when changing the cap or by the dressing not covering enough of the line. If your line is split, you may notice that your dressing is wet, or that the line leaks as it is being flushed. If this happens, do not worry as many lines can be repaired. However, you will need to contact your OPAT nurses for advice. (Contact details given at the end of this booklet) Bleeding from around your line It is normal in the first 24 hours after a line is fitted for you to experience a small amount of bleeding from where the line goes in. However, if the bleeding leaks through the dressing, apply firm pressure over the area for 10 minutes (you will have been shown how to do this by the nurse who inserted your line). If the bleeding continues, please contact your OPAT nurses for advice. (Contact details given at the end of this booklet) page 13 of 16

14 What should I look out for when I go home? A common problem that you may experience is difficulty in flushing your PICC line. Do not force this but contact us here in OPAT where we will be able arrange for you to come to us and unblock your line. If this happens out of hours the ward will arrange for you to come to the ward and they will put an alternative line in and administer your antibiotic if needed, and arrange for you to return to OPAT the following day. Please also contact OPAT if; your PICC line / dressing becomes dislodged, broken or leaking you feel generally unwell you develop a temperature or chills the area around the point where the PICC line goes into your arm becomes red, swollen or sore, or if there is leaking around it How will my PICC line be removed? When you no longer require your PICC line, OPAT nurses will remove it. This is not painful and is done very gently by pulling the line out and then applying a waterproof dressing which can be removed after 24 hours. If you have any questions or need more information, do not hesitate to ask any member of the OPAT team. page 14 of 16

15 Contact details OPAT, E3, Royal Hallamshire Hospital Monday to Sunday: 8.00am 4.00pm Out of hours Ward E2, Royal Hallamshire Hospital Monday to Sunday: 4.00pm 8.00am (always ask to speak to nurse in charge and tell them that you are an OPAT patient) page 15 of 16

16 Produced with support from Sheffield Hospitals Charity Working hard to fund improvements that make life better for patients and their families Please donate to help us do more Registered Charity No organdonation.nhs.uk Alternative formats may be available on request. Please Sheffield Teaching Hospitals NHS Foundation Trust 2015 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. PD6763-PIL2430 v2 Issue Date: June Review Date: June 2017